1. The Field of the Invention
The present invention relates to methods and systems for assisting a requester (e.g., an insurer) in rapidly obtaining medical records from a medical provider (e.g., a doctor). More particularly, the invention relates to methods and systems that employ a computer network which automatically processes and transmits a request and authorization for a medical record from a requestor to a provider and which subsequently receives, matches up, and forwards the medical record in electronic form to the requester.
2. The Prior State of the Art
There are various businesses and other entities that rely heavily on medical records to make business and other critical decisions. These include life insurance companies, property and casualty companies, personal injury attorneys, and patients, which may collectively be referred to as xe2x80x9cmedical record requesters.xe2x80x9d Medical records are typically generated by xe2x80x9cproviders,xe2x80x9d such as, doctors, hospitals, and independent diagnostic laboratories. There is, however, quite a disconnect between medical record providers and the aforementioned requestors such that actually filling a request for a medical record may take weeks or even months.
In a typical scenario for obtaining a medical record a requestor first determines which medical record from which provider is needed. Second, the person to whom the medical records pertain must fill out and send to the requestor a signed authorization form authorizing the provider to release the person""s medical records to the requestor or representative. Third, the requestor sends the medical record request and signed authorization form to the provider. Fourth, the requester either relies on the provider to copy the medical record or sends someone to arrange to copy the requested medical records on the premises of the provider. Fifth, the provider must locate the requested medical record, the vast majority of which are in paper form and filed away in large filing rooms. Sixth, the medical record is photocopied. Seventh, the medical record is sent or otherwise delivered to the requestor. The foregoing process is cumbersome even when the requestor and provider are in close geographic proximity, sometimes even having an ongoing relationship. The process becomes exponentially more difficult when the requestor and provider are separated by large distances, particularly when the two parties do not have an ongoing relationship.
In many cases, doctors and other providers are slow to release medical records and often charge high rates in an attempt to recover what are, at best, the hassle costs of tracking down and providing medical records. This is particularly the case where the provider and requestor do not have an ongoing relationship and/or are separated geographically. In short, doctors and other providers are in the business of providing medical services and are not equipped and motivated to retrieve and provide medical records in a timely and efficient manner.
Likewise, the requestor is typically in the business of writing insurance policies, providing insurance coverage, or performing legal services. At best, obtaining medical records is a significant irritant. Worse, delays in obtaining medical records may mean lost sales to an insurance salesman, delay in processing loss claims, or inadequate or inefficient legal representation by a personal injury or defense attorney. Property and casualty insurers estimate that it costs about $25.00 per open claim per day. Life insurers often lose customers due to delays in being able to close deals and collect premiums. Notwithstanding the tremendous need to rapidly obtain copies of medical records, most requestors of medical records are typically not equipped to efficiently track down and retrieve medical records from the large number of potential providers, many of which have no ongoing relationship with the requester.
Because providers and requesters typically view medical record retrieval and copying to be, at best, an irritating facet of their respective businesses, third party copy services are often employed. Such copy services, in essence, bridge the communication and cultural gaps that separate disparate and essentially unrelated industries that would rather have nothing to do with each other but for the fact that one industry (the provider) produces a commodity (the medical record) that another industry (the requestor) needs but generally cannot generate on its own. While copy services may be better equipped and more willing to be the go-between and courier between requesters and providers, and whereas such services may actually be able to speed up the medical record retrieval and copying processes due to inherent economies of scale and expertise, such increases in efficiency are mostly marginal and do not address the more difficult systemic problems that work together to make the retrieval and copying of medical records an inherently time consuming and inefficient problem.
Aside from the foregoing problems and inefficiencies that presently plague requestors and providers in locating and sharing medical records, the rise of computers, more sophisticated telecommunications devices, facsimile machines, and the global computer network (i.e., the xe2x80x9cInternetxe2x80x9d) show great promise and provide hope in generally increasing the efficiency of how businesses are run and how common and routine activities are carried out. The challenge, however, is implementation. Theoretical and predicted increases in efficiency in the business and manufacturing industries have not been realized and have often lagged behind the expectations of commentators and experts. This is due, of course, to the lack of workable systems that are able to efficiently and realistically implement an automation process. Different types of businesses commonly have very distinct cultures and methods of carrying out their day-to-day operations. More often than not, such differences do not easily lend themselves to quick and obvious automation procedures. For example, it would greatly increase the speed and efficiency of medical record retrieval if such records were electronically created and stored. Unfortunately, about 95% of all medical records are still in paper form and hand written.
In the industry of locating, copying, and providing medical records, there are a number of issues that must be addressed for a document retrieval system to be workable. These include, for example, maintaining the confidentiality of information in a person""s records, ensuring that the copying of a particular record has been legally authorized, preventing the record from being available to or intercepted by unauthorized parties, correctly matching up a particular medical record with a particular request, and preventing unauthorized copying, alteration, or obliteration of data in the medical record. Simply requesting information via e-mail or other unsecured means over the Internet would not adequately address the foregoing concerns.
In short, it would be an advancement in the art of medical record retrieval to provide methods and systems which could greatly accelerate the retrieval process, while maintaining the confidentiality and security of the medical record.
The present invention encompasses medical record retrieval processes and systems, and software for implementing these processes, that greatly streamline the process of obtaining a medical record from a provider on behalf of a requestor. Typical requesters of medical records include life insurers, property and casualty insurers, and personal injury and defense attorneys. In many cases, obtaining a medical record is a condition precedent to entering into a contract, paying out a claim, or having sufficient evidence to prepare a legal case. The present invention greatly reduces the time in which a medical record may be obtained, thus reducing, e.g., monetary costs and lost business.
The processes and systems according to the present invention are advantageously implemented using a plurality of computers which communicate together, typically a computer network or system. In some cases, human assistance may be necessary to locate, process, and send certain data which is then further processed by means of one or more computers.
The inventive processes and systems that enable a requestor to obtain a medical record from a provider advantageously employ one or more centralized data processing centers, comprising one or more computers or computer systems, in communication with remote computers or computer systems employed by the various requesters. The data processing center is also in electronic communication with providers from whom a medical record is to be requested. To help ensure compliance, the data processing center may electronically communicate with one or more telephone calling centers that employ individuals assigned to contact a specific provider while that provider receives an electronic communication from the data processing center. The data processing center may also be in electronic communication with a data conversion device, such as a scanner or fax machine, used to convert a medical record, such as a paper-based medical record, into an appropriate electronic form.
The inventive processes and systems generally include four basic steps and subsystems. First, a request for a medical record and a proper authorization are electronically received from a requestor by a data processing center. Second, the data processing center electronically transmits the request and authorization to a provider. Third, the provider and/or a copy service locates, copies, and sends the requested medical record to the data processing center. Fourth, the data processing center matches up the medical record with the corresponding request, creates an encrypted copy of the medical record, and transmits the encrypted copy of the requested medical record to the requestor or other authorized party.
In the first step and subsystem, the initial request from the requestor to the data processing system is typically generated by means of a computerized request form using software designed to generate standard forms for that requestor. As the request form is generated, a request identification code, such as a serial number, is generated for each request. An authorization form is also generated together with a fax cover sheet or electronic form that includes the identification code. After the data processing center receives the request and authorization, it associates them together by comparing and finding a relationship between their respective identification codes. In a purely electronic system, the identification codes in both the request and authorization will advantageously be in digital text format and thus readily readable by a computer. However, in the present culture, people are used to, and often prefer, hand-signed authorization forms, thus requiring such forms to be faxed or otherwise converted into electronic form, typically as a graphic rather than a text file. To associate the identification code from an authorization fax cover sheet with a corresponding request, a bar code or other scannable image representative of the identification code may be used.
In the second step and subsystem, the data processing center transmits each request and authorization to the one or more providers having access to the requested medical record(s), together with a cover sheet for the medical record that includes the identification code. The data processing center may also transmit the request and authorization to a call center at or about the same time it transmits the request and authorization form to the provider. A designated individual within the call center then places a telephone call to, or otherwise initiates communication with, the provider, preferably to an individual in close proximity to the fax machine or other device that receives the request and authorization. Because it has been found that providers typically respond more readily to a request from a known person, it may be advantageous to assign a particular caller or small group of callers to a particular provider so as to create an ongoing relationship and associated goodwill between certain callers and certain providers.
In the third step and subsystem, the medical record is located, copied, and sent or faxed by the provider or copy service to the data processing center, together with the cover sheet. The cover sheet includes the identification code, typically in the form of a bar code or other scannable information, so that when the medical record and cover sheet are received by the data processing center the medical record can be readily associated with the request by means of comparing the respective identification codes of the cover sheet and request. Medical records are typically in paper form such that they must typically be scanned and converted into electronic form, e.g., as graphics files. This may be advantageously performed by means of a fax machine, such as a fax machine used to send the medical record from the provider to the data processing center. If the medical record is sent by the provider in paper form, the record will typically be scanned and thereby converted into digital, e.g., graphic, form. Medical records may also be received from the provider in electronic form, such as when records are stored by or for the provider in an electronic database. Character recognition software may alternatively be used to convert a medical record into a text file, at least in part.
In the fourth step and subsystem, the data processing center transmits an electronic or facsimile copy of the requested medical record to the requester or other authorized party. A computer can be used to match the medical record and associated identifier code with the original request, as a requestor may often generate multiple requests during a given time period. At some point during or subsequent to the conversion of the medical record into electronic form, the electronic record is advantageously encrypted as a protection against unauthorized access, copying, alteration, or obliteration of the record. If a medical record is sent by the data processing center as an encrypted electronic document, special encryption software, typically password protected software, will be needed to access the medical record, thus maintaining the confidentiality and security of the medical record.
The foregoing medical record retrieval process and system significantly increases the ease and efficiency by which a requestor may obtain a medical record from a provider. The decrease in time and effort required to obtain the medical record significantly decreases the cost associated with having to request and track the location of a medical record. It will also be readily appreciated that after a particular medical record has been converted into electronic form and stored within a searchable database, it may be accessed much more rapidly in the future by simply generating a new request and authorization which identifies the medical record. Because the medical records are encrypted, unauthorized third parties are thus prevented from obtaining, altering, copying, or obliterating the record. Of course, it is also within the scope of the invention to destroy the electronic copy of a medical record, if desired, to maximize confidentiality and protection of the information contained therein.
Another advantage of the inventive methods and systems is that they provide for the creation of an efficient intermediary that is able to bridge the technological and cultural gaps that presently separate requestors and providers. In doing so, the third party intermediary is able, through verbal communication and electronic means, to educate different sectors so that they may, over time, generate more harmonious record production and retrieval systems, thereby prompting an evolution in greater systemic efficiency. For example, the present methods and systems may encourage providers to create electronic copies of medical records to facilitate the transfer of such records to requesters, thus reducing the time providers must typically spend in tracking down and retrieving medical records in tangible form. As the inventive medical record retrieval systems of the present invention proliferate, it will certainly be the case that other industries specializing in data scanning and conversion of paper records into electronic form may enter the scene and revolutionize the manner in which providers generate and store medical records.
Additional features and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by the practice of the invention. The features and advantages of the invention may be realized and obtained by means of the instruments and combinations particularly pointed out in the appended claims. These and other features of the present invention will become more fully apparent from the following description and appended claims, or may be learned by the practice of the invention as set forth below.